摘要
目的探讨静脉应用氨甲环酸(TXA)结合关节腔"鸡尾酒"混合液灌注在初次膝关节置换术(TKA)围手术期的有效性和安全性。方法 90例患者,随机分为实验组A组、对照组B组、对照组C组,每组30例,记录并比较3组术中失血量、隐性失血量、总失血量、总引流量、术后3 d血红蛋白及血细胞比容变化水平,术后静息及活动状态下的VAS评分。结果实验A组术后总失血量、隐性失血量、总引流量、术后3 d Hb下降值、术后3 d Hct下降值低于对照B组、C组,差异有统计学意义(P<0.05),实验A组术后静息及活动状态下膝关节疼痛评分低于对照B、C组,差异有统计学意义(P<0.05)。结论静脉应用氨甲环酸结合关节腔"鸡尾酒"混合液灌注应用于初次膝关节置换,可降低术后总失血量、术后引流量及隐性失血量,能够显著缓解术后早期疼痛,利于早期快速康复,同时不增加血栓发生的风险,且未见不良反应。
Objective To investigate the efficacy and safety of intravenous tranexamic acid（TXA）admin-istration combined with intra-articular＂cocktail＂＋TXA infusion in primary total knee arthroplasty（TKA）. Methods 90 patients were randomly divided to experimental group A,control group B and control group C,30 casesin each group.There was no significant difference（P〈0.05）in the preoperative general informations,such as age,sex,body mass index,hemoglobin,hematocrit,D-dimer,preoperative KSS score,knee activity ROM,VASscores,operation time,time of using tourniquet. All the patients were intravenously injected with TXA 1 g beforeusing the tourniquet. After suturing the capsule,for the group A,100 ml of TXA and cocktail mixture（TXA 1 g,ropivacaine 40 mg,epinephrine 0.1 mg,methylprednisolone 40 mg）were perfused into the articular cavity throughthe drainage which then be clamped. By the same ways,group B patients infused with tranexamic acid solution 100 m L（TXA 1 g）,group C patients infused with saline 100 m L. The total blood loss volume,drainage volume,intraop-erative blood loss,hidden blood loss,the change of hemoglobin and hematocrit in postoperative 3 days,blood trans-fusion,adverse reactions,the VAS scores at 6,12,24,72 h in the postoporative quiescent condition and the VASscores at 12,24,72 h in the postoporative activity condition were measured and compared. Results The volume oftotal blood loss,hidden blood loss,drainage,were（ 685.7 ± 120.6）m L、（259.9 ± 162.0）m L、（151.5 ± 48.9）m L ingroup A,the decrease of hemoglobin and hematocrit at postoperative 3 d were（18.6 ± 3.2）g/L、（3.1 ± 1.3）% ingroup A,there was statistically significant（P〈0.05）comparing with the control groups. The VAS scores of experi-mental group in the resting and the active state were lower than that in control groups（P〈0.05）. Conclusion The application of intravenous tranexamic acid administration combined with intra-articular＂cocktail＂＋ TXA infu-sion can reduce the volume of postop
作者
秦海江
杨青
张永战
QIN Haijiang;YANG Qing;ZHANG Yongzhan(Department of Orthopaedic, the People＇s Hospital of JinCheng （Jincheng Teaching Hospital of First Affiliated Hospital of Zhengzhou University）, Jincheng 408000, Chin)
出处
《实用医学杂志》
CAS
北大核心
2018年第8期1343-1346,共4页
The Journal of Practical Medicine
关键词
全膝关节置换术
氨甲环酸
鸡尾酒疗法
关节腔灌注
Total knee arthroplasty
Tranexamic acid
Cocktail therapy
Intra-articular perfusion
